诊断相关组死亡风险分级在医疗质量评估中的应用

Using diagnosis relative groups mortality risk classification to assess medical quality

目的:尝试引入诊断相关组(diagnosis related groups,DRGs)对医院的医疗质量进行评价,探索评价医院医疗质量的有效方法。方法:利用澳大利亚改良DRGs第5版(AR-DRGs v5.0)对北京市7家三级医院2005年16万出院病例首页数据进行分组。在此基础上进行出院病例死亡风险评分,作进一步的整体性风险调整。然后分别计算各医院不同风险级别病例的住院死亡率,并以此为指标评价医院的医疗质量,同时与直接使用粗住院死亡率进行评价的结果相比较。结果:(1)不同医院收治的病例其死亡风险类型不同;(2)两种方法对医院6的评价结果相似,认为医院6医疗质量较好;(3)医院2的粗死亡率最低(0.98%),但就其中低死亡风险病例的死亡率(0.28%)而言则是高于7家医院这一风险等级住院死亡率的平均水平(0.26%);医院5也有类似的表现。结论:与用粗住院死亡率作评价相比,DRGs死亡风险分级增加了病例的可比性,使得评价结果更为可靠。

Objective： To introduce diagnosis related groups to assess the medical quality and try to establish an effective quality evaluation approach. Methods： Using Australia-Refined Diagnosis Related Groups, version 5.0 （AR-DRGs v5.0） to classify the 160 000 discharged cases from 7 large hospitals in Beijing in 2005. Based on this, mortality risk classification was established to adjust the whole-hospital risks. And then hospital mortality of all the risk groups from each hospital was calculated respectively, which was used as the basic quality assessment criterion. The differences between the assessment results from using the raw hospital mortality and from using Diagnosis Relative Groups Mortality Risk Classification （DRGs-MRC） were compared. Results： （ 1 ） The risk types were different among the discharged cases in different hospitals ; （2） The assessment results from these two approaches about No. 6 hospital were similar in that No. 6 hospital had a good quality performance; （ 3 ） The raw hospital mortality was the lowest in No. 2 hospital （0.98%）, but the mortality of low risk group in this hospital was higher than the average level of the same risk group among these 7 hospitals; the status of No. 5 hospital was much the same. Conclusion： Compared with raw hospital mortality, DRGs-MRC improved the comparability of ca- ses and the reliability of the assessment result.